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Doctors Need Decision Support in Ordering Imaging Diagnostics

Cheryl Clark, for HealthLeaders Media, July 28, 2010

The idea that many primary care physicians would not know what diagnostic imaging tests they should order to diagnose a patient's symptoms might seem incongruous, considering their training and the faith we place in them.

Likewise, it seems implausible that some doctors – perhaps because of time constraints or the confidence they have in their referral base – might fall into a habit of routinely ordering costly CTs, with levels of ionizing radiation at potentially cancer-causing levels, even when an ultrasound, MRI, or a simple X-ray would be a safer choice.

But that is indeed what federal and research reports say has been happening far too often. Additionally, when doctors own the machines, they order more of these tests.

Now, medical journals and federal public policy documents are sounding a refrain: too many doctors are ordering too many expensive, unnecessary and possibly cancer-provoking tests. There has to be a way to curtail it.

That's why the Centers for Medicare & Medicaid Services (CMS) has set aside $10 million for demonstration projects to develop computerized "decision support systems" or DSS programs that assist doctors to make the right choices from among 11 advanced imaging procedures. Thousands of physicians will be recruited, and compensated, to test various systems over a two-year period.

The DSS will give algorithms that help doctors select from the following tests: MRI of the brain, lumbar spine, knee and shoulder, CT of the brain, thorax, sinus, abdomen, pelvis and lumbar spine, and Spect MPI. These are tests associated with high expenditures and utilization in the Medicare fee-for-service population, CMS says. The demonstration will rely on specified medical specialty society guidelines for these procedures.

"Independent of this demonstration, CMS recently examined the trends in ionizing radiation exposure due to diagnostic imaging services among fee-for-service Medicare beneficiaries from 1997 through 2007," the agency said when it announced the demonstration project last week.

"Annual ionizing radiation exposure increased dramatically during this time. Thus, the potential for this demonstration to help reduce unnecessary ionizing radiation exposure has the most definite impact on the quality of care provided to Medicare beneficiaries."

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